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Amphetamine's prescribed use defended by Air Force, M.D.

'Go pill' not primary factor in B-1 crash

The ''go pill'' taken by a copilot 90 minutes before crash landing a Dyess Air Force Base B-1B Lancer is a speed-like stimulant.

Dexedrine, an amphetamine, may have been a factor in the May 8 crash in Southwest Asia because the copilot had not tried the drug before, according to a report released last week by the Air Force's Accident Investigation Board. Normally, an aircraft crew member must ''ground test'' stimulants, called ''go pills,'' before using them during long flights.

''This is the first time I've ever taken a go pill,'' copilot 1st Lt. Jeffrey Flowers, who was not medically cleared to fly, told crewmembers, according to the report.

Dexedrine may have helped Flowers be more alert at the end of an 11-hour mission, according to Lt. Col. Thomas R. Olsen Jr., president of the Accident Investigation Board. He said the main cause of the mishap was pilot and copilot error, directly attributing it to the performance of Flowers and the pilot, Maj. Jonathan Reid, along with poor crew coordination and judgment shortcomings.

Another contributing factor cited in the report was that the copilot was overwhelmed with more tasks than he could handle when the pilot unexpectedly turned over control of the aircraft.

Neither Reid nor Flowers are currently flying and both face disciplinary action that has yet to be determined, Dyess spokeswoman Capt. Paula Bissonette said.

Flowers suffered a minor back injury from the crash. The three other crew members, all assigned to Dyess, were not injured.

The B-1B crew was returning to Diego Garcia, a remote Indian Ocean island, from an 11-hour mission when the bomber landed gear up, skidding 7,500 feet down a runway and sustaining $7.9 million in damage.

'Go pills'

The Drug Enforcement Agency classifies Dexedrine as a Schedule II drug, spokeswoman Rogene Waite said. The lower the number on the schedule, the higher the abuse potential, more controls and fewer medical uses a drug has. Heroine, for example, a Schedule I drug, is an illegal substance with no medical use, Waite said.

Both Dexedrine and Modafinil are prescribed by the Air Force for pilots to use during flights that are 12 hours or longer. Modafinil is a Schedule IV stimulant with significantly less abuse potential and more medical uses. It is commonly used to treat narcolepsy.

Usually, the Air Force tests pilots to see how they react to the drugs before prescribing them to combat the kind of fatigue caused by long, cross-continental flights often flown in the B-1.

''The idea is to keep people awake and alert, maybe sometimes well past the time when they would be tired,'' said Dr. Don Hudson, a Denver aviation medicine consultant and retired Air Force flight surgeon.

Typically, flight surgeons tell pilots to take a stimulant on a long flight as needed or 30 minutes prior to any critical phase of flight, such as landing or aerial refueling. Some flights begin when a pilot would normally be sleeping or take the pilot across multiple time zones, said Col. Scott Vander Hamm, Operations Group commander for the 7th Bomb Wing at Dyess.

The investigation

The crash investigation report said Flowers had not flown in 30 days and that he had only 14.1 hours of flight time in the prior 60 days.

He was removed from flying duty in April so he could try medicine that all crew members must test, including stimulants. Flowers did not return to the flight surgeon's office at the end of the test period so he could be cleared for flying duties, said Vander Hamm.

The report also said Flowers may suffer from a disorder hampering his ability to tell left from right and to handle multiple tasks. The report said Flowers had no medical condition that would prevent him from flying.

The report said Flowers' neurological problem could have been exacerbated by taking a stimulant during the flight. Flowers had not been approved to take stimulants. He said in the report he took a pill, which is 5 milligrams, but did not say where he got it. By his description, the pill was most likely Dexedrine. His post-mishap toxicology reports were negative.

He said he had been tested for ''go pills'' a year earlier, but his medical records did not reflect that.

Bad reputation

Typically, small amounts of Dexedrine, whose generic name is dextroamphetamine sulfate, produce no side affects, said Dr. John Gullett, an Abilene physician who examines the medical status of civilian pilots for the Federal Aviation Administration.

''It's like drinking some coffee. It makes you more awake, more alert,'' said Gullett, who is also an infectious disease specialist. ''Years ago, when I was in medical school, we all took it so we could stay up late and take exams.''

Gullett said Dexedrine has acquired a bad reputation because people have abused it. People have used it for weight loss. Truck drivers have used it to stay awake during long road trips. Gullett said the drug delays the time a person wants to sleep. ''At some point you have to sleep it off,'' he said.

Side effects can include restlessness and over-stimulation, according to the online ''Physicians' Desk Reference.'' The reference book said Dexedrine should not be taken to improve mental alertness or to stay awake and can be addictive if taken for a long period of time.

It also says the drug can impair judgment and coordination, and people should not drive or operate heavy machinery until they know how they will react to the medication.

The usual dosage is 5 to 60 milligrams a day, the medical reference book said.

Gullett said Dexedrine is still used to treat severe depression. But it would be illegal for commercial airline pilots or truck drivers to take the drug.

The physician said the Air Force has special cases, such as long flights under stressful circumstances.

Military conditions

Dr. Russell B. Rayman, executive director of the Aerospace Medical Association, served in the Air Force for 25 years and as a flight surgeon occasionally prescribed stimulants.

''I have never seen any significant side effects,'' he said.

The squadron flight surgeon would give very small doses to crewmembers, sometimes one to three pills, Rayman said.

At the end of the mission, crew members are asked if they used the pills, and, if not, the pills are destroyed, he said.

Prescribing ''go pills'' is the exception, not the rule, Rayman said.

''In my opinion, under the conditions used by the military, it's the right thing to do,'' he said. ''To my knowledge, there's never been an accident or untoward incident due to these medications.''

A military analyst said he used to be concerned about the Air Force's use of ''go pills'' because persistent use can induce paranoia and, at the least, make people irritable and even aggressive.

''It was a specific problem that they had with pilots flying long-range missions to Afghanistan in single-cockpit aircraft,'' said John Pike of GlobalSecurity.org, a Washington defense research firm.

Pike said he thinks the Air Force now either stations aircraft in Afghanistan or flies multiengine, multi-crew aircraft out of Diego Garcia, the island where the Dyess B-1B crashed.

Pike agreed with the president of the Accident Investigation Board, one member who didn't think Dexedrine was a factor in the crash.